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change was 11.91�12.02 and 19.55�15.90, respectively; and FIM efficiency score was.2867�.4265 and 1.4276�1.5205, respectively. ISO patients, compared with non-ISO, had astatistically significant increased LOS, increased charges, and lower FIM efficiency scores. Nostatistical significance was seen in FIM change between the 2 groups. Conclusions: We found thatpersons with SCI in isolation had a significantly longer LOS and increased medical charges resultingin lower FIM efficiency score. Ultimately, FIM changes did not differ significantly between groups.Thus, both groups eventually reached similar functional gains, but the nonisolation group reachedthem with a lower LOS, less cost, and greater efficiency. Key Words: Drug resistance; Rehabili-tation; Spinal cord injuries.
Poster 192A CD-ROM–Based Virtual Patient Teaching Resource on Spinal Cord Injury. Sunil Sabhar-wal, MD (Medical College of Wisconsin, Milwaukee, WI); Deborah Simpson, PhD; ThomasineDankert, e-mail: [email protected]: None.
Setting: A US medical school. Program: In consultation with basic scientists and clinicians, areal-life case of a patient with SCI was adapted to ensure that critical basic science and clinicalissues emerged. Program Description: The patient ages over time, providing a longitudinalperspective on changes over a 30-year period after injury. Case details were transcribed into a videoscript, with each scene under 2 minutes in length to allow for ease of insertion into existingcurriculum. The video was digitized for ease of access on a CD-ROM that also includes images,radiograms, lab results, and other files that highlight specific aspects of the case. To facilitate access,the CD is indexed by specific topics (eg, sensory nerves) or by course (eg, physiology). For example,a patient’s neurologic findings are used in an anatomy lecture on spinal dermatomes, and used laterin clinical clerkships to teach neurologic examination. A scene with the patient refusing to be turnedin bed is used to discuss decision-making capacity in a medical ethics course. The same scene isused in clinical rotations to stress positioning after paralysis or to discuss patient compliance.Assessment/Results: Response by faculty to this initiative has been very positive. The virtualpatient with SCI has been incorporated into multiple clinical and basic science courses at ourinstitution. Discussion: Based on positive feedback, the CD-ROM is being distributed nationally.Conclusion: This initiative incorporates SCI and disability education in an overflowing medicalcurriculum by supporting concepts that are already being taught. Key Words: Medical students;Problem-based learning; Rehabilitation; Spinal cord injuries.
Poster 193The Effect of Hand Dominance on Motor Recovery in Incomplete Cervical Spinal CordInjury. Jason H. Lee, MD (Thomas Jefferson University, Philadelphia, PA); Anthony Burns,MD; William Staas, MD, e-mail: [email protected]: None.
Objective: To determine the relationship between hand dominance and motor recovery inincomplete cervical spinal cord injury (SCI). Design: Retrospective analysis using neurologicassessment at admission and 1 year or later postinjury. Hand dominance prior to injury was obtainedvia telephone. Setting: Regional SCI center affiliated with a university hospital. Participants: 58subjects (51 right handed, 7 left handed) with incomplete cervical SCI. Interventions: Traditionalmedical and rehabilitation care. Main Outcome Measures: Motor point recovery per extremity andpercentage recovery per extremity. Percentage recovery was defined as actual motor point recoveryper extremity divided by maximum possible motor point recovery per extremity. Outcome measureswere analyzed for statistical significance using Wilcoxon test for P values, the Hodges-Lehmannestimates for median differences, and 95% confidence intervals (CIs). Results: The average motorpoint recovery for upper extremities was 7.84 for the dominant side and 8.97 for the nondominantside. Corresponding values for the lower extremities were 7.19 for the dominant side and 7.66 forthe nondominant side. The percentage recovery for the upper extremities was 50% for the dominantside and 51% for the nondominant side; for the lower extremities, 38% for the dominant side and36% for the nondominant side. The median difference between dominant and nondominant motorpoint recovery for the upper extremities was –1.0 point (95% CI, –3.0 to 0.5) and –0.5 points (95%CI, –3.5 to 2.5) in the lower extremities. The median difference between dominant and nondominantpercentage of motor recovery was –4% (95% CI, –13% to 5%) in the upper extremities and –2%(95% CI, –12% to 12%) in the lower extremities. P values failed to reach statistical significance(P�.05). Conclusions: Hand dominance does not influence motor recovery in incomplete cervicalSCI. Key Words: Dominance, cerebral; Rehabilitation; Spinal cord injuries.
Stroke
Poster 194Association Between Community Independence Level and the Ability to Perform EverydayTasks in Community-Dwelling Stroke Survivors. Elliot J. Roth, MD (Rehabilitation Instituteof Chicago, Chicago, IL); Linda L. Lovell, BS; Rita K. Bode, PhD; Richard L. Harvey, MD,e-mail: [email protected]: None.
Objective: To describe the relationship between functional independence in basic activities ofdaily living and instrumental activities of daily living (IADLs) of stroke survivors living in thecommunity. Design: Prospective, cohort, observational study. Setting: Community. Participants:Stroke survivors living in the community 1 year postdischarge from an acute inpatient rehabilitationprogram. Interventions: Not applicable. Main Outcome Measures: A structured survey wasadministered by telephone. Outcome measures were the Frenchay Activities Index (FAI), a measureof IADLs (scores can range from 15 to 52), and the FIM™ instrument, a measure of disability(scores can range from 18 to 126). Results: 57% of the stroke survivors were white, with a meanage � SD of 63.8�14.4 years. The sample was evenly split between men and women. The majorityof stroke patients (92%) were living in a private residence. The mean FIM score was 95.9�26.8 andmean total FAI score was 26.8�9.7. There was a significant and positive correlation between FAI
scores and FIM scores (r�.73, P�.001). Visual inspection of the relationship between FAI scoresand FIM scores revealed that the data largely followed a curvilinear pattern. Curve estimationregression models were used to determine the line of best fit. A cubic function was found to givea good fit with an R2 of .679. A score of approximately �80 on the FIM was associated with asubstantially increased level of participation in home and community activities. Conclusion: Therewas a strong relationship between the level of participation in IADLs and level of functionalindependence. Key Words: Activities of daily living; Cerebrovascular accident; Disability evalu-ation; Rehabilitation.
Poster 195Focal Dystonia After Stroke Leading to Trismus: A Case Report. Michael T. Engle, MD (OhioState University, Columbus, OH); Vivek Kadyan, MD; Albert Clairmont, MD, e-mail:[email protected]: None.
Setting: Midwest acute inpatient rehabilitation hospital. Patient: A 58-year-old woman. CaseDescription: The patient was diagnosed with a middle cerebral artery and lacunar stroke on January9, 2002. She was admitted to acute inpatient rehabilitation on February 14, 2002, and was found tohave trismus on the second day of admission. Differential diagnoses included: tetanus, abscess,dislocation, slipped disk, fracture, volitional noncooperation, and dystonia. Plain films followed byfacial computed tomography with thin cuts did not reveal pathologic findings. Manipulation atbedside with sedation and bilateral masseter muscle block did not result in resolution of trismus.Treatment for tetanus was initiated while titer results were pending. The patient subsequentlyunderwent exam under anesthesia, where her jaw was opened fully and no evidence of fractures,abscess, or dislocation was noted. Facial electromyography revealed increased activity in the lefttemporalis muscle, consistent with spastic dystonia. The tetanus titers were negative and the mostlikely diagnosis was focal spastic dystonia. Aggressive treatment was pursued because the patientwas unable to accept oral intake and had been at severe nutrition risk since the onset of trismus.Tizanidine was started, and she received adjunctive treatment with 10U of botulinum toxin type A(BTX) by electromyographic guidance to the left temporalis muscle. 6 days later, she had partialresolution of her trismus and was able to tolerate oral intake. Assessment/Results: Focal dystoniaof the left temporalis muscle. Discussion: Alterations in muscle tone are a common finding afteracute stroke. However, this case demonstrates an unreported complication of stroke, and theimportance of dystonia in the differential diagnosis of trismus. We demonstrate the use of BTX forfocal spastic dystonia in the acute rehabilitation setting. Conclusions: Focal dystonia of thetemporalis muscle is a rare complication of stroke, and must be considered in the differentialdiagnosis of trismus. Key Words: Cerebrovascular accident; Rehabilitation; Trismus.
Poster 196Fatigue in Stroke Patients During Acute Inpatient Rehabilitation. Christina Kwasnica, MD(Barrow Neurological Institute, Phoenix, AZ); Susan Borgaro, PhD; Heather Caples, PhD,e-mail: [email protected]: None.
Objective: To compare patients’ reports of fatigue between inpatient rehabilitation participantsand healthy controls. Design: Cohort study. Setting: Inpatient neurorehabilitation unit. Partici-pants: Inpatient rehabilitation participants and neurologically normal controls. Interventions: Notapplicable. Main Outcome Measure: Barrow Neurological Institute (BNI) Fatigue Scale. Results:Participants responses on the 11-item BNI Fatigue Scale were recorded for 3 groups: those admittedfor cerebrovascular accident (CVA) (n�21), those admitted for other neurologic diagnoses (n�26),and normal controls (n�20). The BNI Fatigue Scale asks patients to describe their level of difficultyon 10 fatigue-related items, such as staying awake during the day or participating in activitiesthroughout the day. A final item (item 11) asks patients to provide an overall rating of their fatiguein the early stages after brain injury. The CVA group reported significantly more fatigue on the totalitems combined than the non-CVA group, and the non-CVA group reported significantly morefatigue than the normal controls (F2,112�8.51, P�.001). Individual items were examined todetermine group differences. Alpha was set at .005 to control for multiple comparisons. The CVAgroup reported significantly more fatigue than the control group on items 3, 4, 7, 10, and 11, withthe CVA group reporting significantly more fatigue than the non-CVA group on items 3 and 10 (allP�.005). Conclusions: For inpatient rehabilitation participants, fatigue is a common influencingfactor. Stroke patients reported higher fatigue levels even as early as acute rehabilitation, which caninfluence participation in therapies. This difference can be see in comparison to other non-CVAdiagnoses, as well as to normal controls. Interventions can be aimed at relieving fatigue, bothbehaviorally and pharmacologically. Future studies must also assess the degree of fatigue inindividual patients and how it impacts level of function during inpatient rehabilitation. Key Words:Cerebrovascular accident; Fatigue; Rehabilitation.
Poster 197Hypotension in Poststroke Patients: Effects on Outcome. Amir M. Qureshi, MD (University ofArkansas for Medical Sciences, Little Rock, AR); Richard P. Gray, MD; Danell Mauldin,OTR; Alice V. Fann, MD, e-mail: [email protected]: None.
Objectives: To evaluate (1) the incidence of orthostatic hypotension and hypotension withoutdocumented orthostatic blood pressures in poststroke patients who participate in inpatient rehabil-itation, and (2) whether hypotension increases length of stay (LOS) or FIM™ instrument changescompare with stroke patients who do not have hypotension. Design: Retrospective study. Setting:Veterans Affairs inpatient rehabilitation ward. Participants: 75 subjects (74 men, 1 women) withfirst-time acute cerebrovascular accident admitted to rehabilitation floor. Interventions: Not appli-cable. Main Outcome Measures: Acute and rehabilitation LOS, admission and discharge FIMscores, FIM change, and FIM efficiency (FIM change/rehabilitation LOS). Results: 25 subjects hadhypotension, 7 of 25 subjects had orthostatic hypotension, and 18 of 25 had hypotension (at least�20mmHg decrease in blood pressure from the baseline with or without dizziness) withoutdocumented orthostatic blood pressures. 50 subjects had no hypotension. Hypotension subjects had
A38 ACADEMY ANNUAL ASSEMBLY ABSTRACTS
Arch Phys Med Rehabil Vol 84, September 2003